A health makeover for an entire town?

The citizens of New Ulm, Minn., like to joke about their three major food groups -- beer, brats and butter with a little cheese thrown in for good measure.

That's part of what makes New Ulm a perfect place for a groundbreaking experiment on whether it's possible to eliminate heart attacks throughout an entire community.

The ambitious New Ulm experiment is one of two Allina Hospitals and Clinics plans to announce today in a five-year, $100 million health initiative it has named the Center for Healthcare Innovation.

The other experiment is aimed at discovering if Allina can affect the health of those who live right in its back yard -- the Phillips and Powderhorn Park neighborhoods of Minneapolis where Allina is based.

That community, with a population equal parts Hispanic, African American and white, is rife with chronic social and health problems such as obesity, asthma, teen pregnancies and HIV infections.

Both New Ulm and the south Minneapolis neighborhoods will become what Allina officials describe as living laboratories on how to prevent disease and do a better job of treating it when it does occur.

"It's working on the things that cause illness upstream rather than waiting for something to go wrong and fixing it later," said Donald Berwick, head of the Institute for Healthcare Improvement in Cambridge. Mass.

He said Allina is at the leading edge of what he expects will become a trend of community interventions because "in the end it's the only way we can get at the big burden of the cost of care."

It is also a way for Allina, the Twin Cities' largest health care organization, to expand its nonprofit mission, said Dick Pettingill, Allina's chief executive officer. Community leaders "looked us squarely in the eye and said, 'We expect more from you,'" he said.

Allina's board of directors is expected to approve the project and the funding at a meeting today. To pay for the center, Allina will ante up $50 million of its revenues during the next five years and seek another $50 million in grants and donations from other organizations.

Pettingill said that Allina will use the next seven or eight months to establish goals and programs with community groups in New Ulm and Minneapolis, and hire staff.

Why New Ulm?

New Ulm was chosen for the heart attack project, called the Heart of New Ulm, because more than 90 percent of its 15,000 citizens get their health care from Allina. Both the clinic and hospital there are owned and operated by Allina.

It also has an electronic medical records system, which provides new and untested opportunities for population research, said Dr. Kevin Graham, a cardiologist at the Minneapolis Heart Institute involved in developing the project.

He said that the records system can help doctors identify people who are at risk for heart attacks and figure out which treatments are effective.

"The patients [at risk] for heart attacks and with lower cholesterol, those are the ones we need to find," he said. "The ones who smoke three packs a day are not difficult to intervene on."

The greater question, however, is whether Allina can reach beyond the clinic walls and lead the community toward an extraordinary goal that requires people to do far more than take heart medications.

"To actually get up and get moving and eat more fruit, that is the hard part" said Dan Beranek, a member of the New Ulm City Council for 30 years.

Graham said many of the biggest decisions will have to be made by the community itself, not its doctors. "Do you stop selling cigarettes in New Ulm?" he asked.

In the neighborhood

The Minneapolis initiative, called the Backyard Project, is larger and, Pettingill acknowledged, more complex.

He said the center will be a clearinghouse for established community groups. "There are 50 nonprofits in our back yard, but no air traffic controller to make it work," he said.

Minneapolis Mayor R.T. Rybak said he was among community leaders who encouraged Allina to ensure its non-profit status was reflected by more than its tax return. When Pettingill described the new projects recently, "I was pleasantly stunned by the scale and the innovation," Rybak said.

Chronic diseases are often rooted in social problems, such as bad diets, broken families, smoking and dropping out of school, said Michael Oakes, a University of Minnesota epidemiologist who studied Phillips for Allina.

"The science is not clear. We have thousands and thousands of research papers and no one can say whether there will be health benefits if you take soda out of the schools or build a park. We don't know."

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